Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $80.97 / $449.33 / $612.50	Facility		$80.97	$449.33	$612.50
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.83 / $37.38 / $76.27	Facility	26	$27.83	$37.38	$76.27
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $47.72 / $272.41 / $587.09	Facility	TC	$47.72	$272.41	$587.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.69 / $33.72 / $100.81	Professional		$24.69	$33.72	$100.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.08 / $11.96 / $53.84	Professional	26	$8.08	$11.96	$53.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $20.04 / $66.62	Professional	TC	$16.60	$20.04	$66.62
Cigna Facility/Professional Facility Modifier Low / Median / High Price $386.22 / $386.22 / $386.22	Facility		$386.22	$386.22	$386.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.50 / $70.94 / $106.72	Professional		$45.50	$70.94	$106.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.25 / $27.96 / $32.02	Professional	26	$13.25	$27.96	$32.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.25 / $42.98 / $76.67	Professional	TC	$32.25	$42.98	$76.67
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $31.76 / $33.59 / $157.61	Facility		$31.76	$33.59	$157.61
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $72.22 / $87.33 / $188.98	Professional		$72.22	$87.33	$188.98
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.54 / $27.33 / $74.81	Professional	26	$22.54	$27.33	$74.81
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $48.88 / $62.10 / $148.53	Professional	TC	$48.88	$62.10	$148.53
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $122.85 / $183.27	Professional		$100.00	$122.85	$183.27
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.50 / $37.70 / $58.11	Professional	26	$32.50	$37.70	$58.11
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $67.50 / $87.75 / $125.16	Professional	TC	$67.50	$87.75	$125.16
Providence Facility/Professional Facility Modifier Low / Median / High Price $33.59 / $40.31 / $386.22	Facility		$33.59	$40.31	$386.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $39.11 / $100.00 / $175.95	Professional		$39.11	$100.00	$175.95
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $26.00 / $39.00 / $59.02	Professional	26	$26.00	$39.00	$59.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $51.00 / $84.00 / $125.16	Professional	TC	$51.00	$84.00	$125.16
United Facility/Professional Professional Modifier Low / Median / High Price $41.82 / $77.33 / $177.18	Professional		$41.82	$77.33	$177.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.98 / $26.67 / $64.41	Professional	26	$12.98	$26.67	$64.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $54.99 / $111.98	Professional	TC	$28.84	$54.99	$111.98